Vida Abedi, Alia Saberi, Peyman Nowrouzi-Sohravi, Soheil Naderi, Mahtab Ramezani, Ashkan Mowla, Reza Bavarsad Shahripour, Annemarei Ranta, Mohammad Ghorbani, Ramin Zand, Mehmet Hanci, Orkhan Alizada, Oluwaseyi Olulana, Apoorva Dev, Emmanouil Karofylakis, Nasrin Rahimian, Shima Shahjouei, Faezeh Khodadadi, Nima Ostadrahimi, Georgios Tsivgoulis, Stefania Mondello, Durgesh Chaudhary, Arash Kia, Saeideh Aghayari Sheikh Neshin, Behnam Rezai Jahromi, Venkatesh Avula, Mika Niemelä, Shailesh Male, Sakineh Ranji-Burachaloo, Nitin Goyal, Sotirios Tsiodras, Martin Punter, Christoph J. Griessenauer, Achille Cernigliaro, Mahsa Mashayekhi, Mirna Sabra, Jiang Li, Paraskevi C. Fragkou, Ayesha Khan, Ghassem Farahmand, Seyed Amir Ebrahimzadeh, Askar Ghorbani, Alaleh Vaghefi Far, and Seyed Aidin Sajedi
Background: There has been increasing attention on cerebrovascular events (CVEs) following SARS-CoV-2. The goal of this study was to better depict the short-term risk of CVEs and its associated factors among SARS-CoV-2 hospitalized patients. Methods: This multicenter, multinational observational study includes hospitalized SARS-CoV-2 patients from North and South America (United States, Canada, and Brazil), Europe (Greece, Italy, Finland, and Turkey), Asia (Lebanon, Iran, and India), and Oceania (New Zealand). The outcome was the risk of subsequent CVEs. The counts and clinical details of the patients with and without a CVE were received according to a predefined protocol. Quality, risk of bias, and heterogeneity assessments were conducted according to ROBINS-E and Cochrane Q-test. The risk of subsequent CVEs was estimated for individual states/districts, countries, continents, and within industrialized countries through meta-analyses with random effect models. Bivariate logistic regression was used to determine the parameters with predictive outcome value. The study was reported according to the STROBE, MOOSE, and EQUATOR guidelines. Findings: We received data from 26,133 hospitalized SARS-CoV-2 patients from 99 tertiary centers in 65 states/districts. A total of 17,774 patients were included in meta-analyses. Among them, 156 patients had a CVE complication—123(78·8%) ischemic stroke, 27(17·3%) intracerebral/subarachnoid hemorrhage, and 6(3·8%) cerebral sinus thrombosis. The meta-analyses indicated an overall 0·3%-1·2% risk of CVEs. Dependency on a ventilator and the presence of ischemic heart disease were predictive of CVEs. Interpretation: Although there is an increased risk of CVEs among SARS-CoV-2 patients, the risk is comparable to other viral infections and critical conditions. Funding: None Declaration of Interest: Neither I (Ramin Zand, corresponding author) nor any of the co-authors have a financial, commercial, legal, or professional relationship with other organizations, or with the people working with them, that could influence our presented research. Ethical Approval: The study receivedapproval bythe Institutional Review Board of Geisinger Health System and other participating institutions when it was required.